Photo: iLab/CSIS
This transcript is from a CSIS event hosted on December 19, 2024. Watch the full video here.
Katherine E. Bliss: Climate change and global health, two fairly straightforward, simple terms, but put together they can generate a fair amount of emotion and discussion. And there are a lot of different directions that that conversation could go. Are we talking about the ways in which a changing climate might be contributing to the emergence and spread of new infectious diseases? When we talk about climate change and health, are we talking about the ways in which climate may – climate change or changing conditions may make it more difficult for people to access healthcare or may exacerbate existing health conditions? Are we talking about the ways in which medical supply chains may be, you know, affected by changing weather patterns, whether heat or flooding or other kinds of conditions? Or is it something else?
On today’s CommonHealth Live, Stacy Aguilera-Peterson and Josh Glasser, both from the White House Office of Science and Technology Policy, OSTP – I got that right, thank you – (laughter) – will join me to discuss answers to these questions, and more. How should we think and talk about climate change and health? What is the link between domestic and international issues when it comes to this intersection? And what are the most promising paths forward for national and global collaboration to address some of these challenges?
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Stephen Morrison: This is the CommonHealth, from the CSIS Bipartisan Alliance for Global Health Security, engaging senior leaders on questions of how to address our common health security challenges in this post-COVID moment.
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Dr. Bliss: Hello and welcome to the CommonHealth Live a broadcast and podcast of the CSIS Bipartisan Alliance for Global Health Security. I’m Katherine Bliss, senior fellow with the CSIS Global Health Policy Center, where I lead our work on immunizations and health systems resilience. Today I’m joined by Stacy Aguilera-Peterson, deputy director for research, U.S. Global Change Research Program at the White House Office of Science and Technology Policy. And by Josh Glasser, assistant director for combating antimicrobial resistance and integrated health innovation, or One Health, also at OSTP.
We’ll discuss how the Biden administration has defined the relationship between climate and health, the extent to which the domestic experience of climate impacts on health is motivating policymakers to take climate and health issues seriously, and how that may translate to concerns about climate and health overseas. And we’ll also talk about opportunities for stakeholders in research, program implementation, service delivery, and the private sector to collaborate with U.S. government agencies and international partners on addressing challenges at the intersection of climate change and global health. Stacy and Josh, welcome to the CommonHealth Live.
Josh Glasser: Thank you for having us.
Stacy Aguilera-Peterson: Thank you.
Dr. Bliss: So climate change and public health are vast fields of concern on their own. There are journals and Ph.D., and, you know, many different areas of inquiry and discussion related to each of these two topics. But even if we focus more narrowly on where they intersect, it’s still a relatively broad set of issues. And they’re not without controversy, in some ways. And certainly since the pandemic the concept of global health can make people nervous. And in some circles, there’s also an unwillingness to really talk about climate or climate change, or to use all these words together.
So, Stacy, I want to start with you. You’re an oceans policy, oceans researcher – oceans policy specialist. And at OSTP, you’ve really had a front seat, you know, an up close view of what works and what doesn’t when talking about climate and climate change research and, you know, really, how we think about and move these issues forward in the United States. So could you start by saying a bit about your office’s priorities and, really, kind of the key areas of impact, you know, in this area, the research area that you’ve been looking at over the past few years?
Dr. Agilera-Peterson: Yeah, definitely. Thank you. It’s so great to be here.
You know, I think the narrative has really changed over the last, say, 20 years. You know, the question has been, is climate change real? And now the question that we’re hearing more and more from others is, what do we do about it? And the scientific community is – has been, you know, fighting to say, yes, like, climate change is real. Here’s all the evidence. Here’s how we know what we know.
And now they have to respond to a whole suite of other questions about what do we do, how do we plan – you know, what time frame are we thinking about here, and that’s a whole other suite of questions.
And so that narrative relates to the health sector definitely as health professionals think about planning and, you know, thinking about infrastructure and thinking about your own patients. But in terms of the research, we’ve been focused on providing the authoritative data that anyone can look forward to in their decision making.
So the U.S. Global Change Research Program, or USGCRP, it was founded in 1990 by the Global Change Research Act. So it’s in law, and through the USGCRP we’re providing the research and the services coordinated across 15 different agencies in the federal government to inform the nation in navigating the challenges of a changing environment and to also provide opportunities for how can we create a more resilient and equitable future.
So through working with the different agencies we’re providing tools, resources, highly influential scientific assessments, which I can talk about – the National Climate Assessment is a really big one that we produce – and we’re working to coordinate across the federal government the delivery of those climate information and services to people from all different sectors.
Dr. Bliss: So this is codified into law. I mean, it’s been there for 30-something years. Just before we go on, could you say a little bit about, you know, why we’ll see some programs called global change and then, you know, within that you have then the focus on climate change?
Can you just explain those different terminologies and how they’re used?
Dr. Agilera-Peterson: Definitely. I think the creators of the Global Change Research Act saw environmental change broadly, holistically, knowing that nature loss, biodiversity loss, is connected with climate change.
And so while the Global Change Research Program has historically focused a lot on climate. Over the last couple years particularly in this administration we’ve been looking more into nature loss in biodiversity.
We’re conducting the first ever national nature assessment which will be very similar to the National Climate Assessment and summarizing all of the scientific data and information we know about nature, and so that term global change is a broader term in which climate change fits under.
Dr. Bliss: OK. Thank you. That’s helpful and explains why sometimes we see fields that we might think are not connected but really kind of all fall under that large category.
So, Josh, I want to turn to you. I mean, you’re looking at some of these issues coming from the health policy side of things. The Biden administration has not shied away from talking about climate and health, and it even opened an office of climate change and health equity at Health and Human Services, and has also mentioned, you know, these connections in some of the foreign policy like the U.S. global health security strategy that came out in April of this year.
Can you say a bit about, you know, really, how the administration has sought to define that linkage between climate and health, considering all the different ways that it could be considered – what, you know, really you see as the most important areas of impact and outreach?
Mr. Glasser: Yeah. Thank you, first off, so much for having us on the podcast today. I think this is an excellent opportunity to really take stock of where we’ve come from and, perhaps, where we’re going as well.
At the White House we held a forum back in August of this year – a White House climate and health forum that drew in, I think, about two dozen agencies and equivalent number of organizations from civil society, and as you noted at the top the array of topics was really quite breathtaking.
But as I thought about it after the meeting it emerged to me that there were really three broad agendas or three broad domains that were coming together in the course of this meeting.
The first of them was around information. Stacy alluded just a moment ago to the incredible value of climate information. Of course, that needs to be blended with more traditional types of information like demographic and epidemiologic information, and critically it needs to be in the hands of the right people in the right time and the right place so that they can act on that information and save lives. That’s one very broad agenda but I think it stands as kind of a package.
The second, I think, is around people. Health is a social sector. It’s composed of people. It serves people. There are patients, there are health providers, there are support staff, there are loved ones who are all part of the health system. Many of them are seeing the impacts of climate right outside their front doors every day. They’re seeing it in their clinics every day. And so they want to take an active role and they are eager to participate with training, education, and inclusion in these types of processes. And so from the federal government on down to the very local most, there, I think, is a major impetus towards how do we think about the people of the health system and engaging them proactively in climate and health.
And then, finally, I think on the built environment, we have a huge health system, multiple trillions of dollars that depends on supply chains that go across vast distances, depends on of course medical products but also energy and water and food. It depends on people being able to access the facility as patients or as providers. All of that infrastructure needs to be addressing climate, both from its own emissions perspective – which is quite significant, both in the U.S. and internationally – but also in terms of its resilience. I mean, we’ve all seen in recent years when health supplies are scarce or when there are challenges and shocks to the system people rely on health systems to provide. And so we need to think about how health systems can be resilient against climate shocks as well.
Dr. Bliss: So both of you have raised the importance of information, of gathering data and analyzing it and presenting it in an authoritative way so that people can make decisions about resources, about, you know, responding to current challenges. But also, the – Josh, I mean, you’ve just also raised the importance of infrastructure, whether, you know, roads and that kind of thing, but also just, you know, the supply chains. And obviously, during COVID we saw a lot of discussion and challenge around many of the issues with supply chains. And you know, that led to a lot of discussion about, you know, really, how do we – how do we link this climate – this set of issues around climate and health with national security. And so I wanted to – maybe to start with you because, you know, you’ve raised both of these issues. You know, to what extent do you – have you found it helpful, or is it helpful, or, you know, is it seen that these are national security challenges? And you know, is there – is that – as we think about some of the conflicts, you know, that Stacy mentioned, you know, about, you know, for 20 years or so people didn’t even want to kind of think that there was a problem, and now suddenly there’s more of a focus on finding ways to respond – is placing climate and health in a national security framework helpful for kind of getting people’s attention and really focusing on policy solutions?
Mr. Glasser: Certainly. Well, Katherine, thank you for the question. And I think, no question, the national security sector is addressing the issue, is taking it proactively. But I might step just a step back from that to pointing out why we are particularly concerned about climate change. And that’s because it affects all of our life support systems here on Earth. It affects the air we breathe, the water we drink, the food we eat, the places we go, the transportation that’s available to us, the healthcare and education that’s available to us. And so fundamentally, from that perspective, if that really ties into our human security, our ability to live a good life, our ability to have healthy communities, when you take away those things or risk those things it creates a lot of instability in the system.
And once instability is in the system, all sorts of negative outcomes can start to unfurl. People are, you know, often challenged to find resources via whatever means necessary. There can be conflicts over those resources. There also, of course, can be cooperation. Sometimes in our times of greatest crisis that is when people pull together and really cooperate to make things happen. But I think fundamentally thinking about this as far as, you know, the life support systems that keep us alive here on planet Earth, much like you would be concerned if you were scuba diving under the ocean and your scuba tank went out, this is exactly the type of issue that we need to be thinking about as a first and foremost type of issue, so that hopefully we can cut off some of the potential avenues towards conflict and steer ourselves towards cooperation.
Dr. Bliss: So really the issue – I mean, accepting – you know, we can – we can think about there – as you just said, about the conference in April – was it April or August?
Mr. Glasser: August, mmm hmm.
Dr. Bliss: August. But that – there are so many different ways to look at the problem. But, you know, that the potential for conflict is really one of the – one of the key reasons that we might want to kind of continue to think about how we frame climate and health in a security context.
Stacy, let me – let me turn to you, you know, on the research issues a little bit. I know you said there are at least 15 different agencies that are undertaking assessments and gathering data. Many of them, of course, are involved in international collaborations of sharing data and building data sets together to really do some of the forecasting. Is the – is the national security argument, you know, within the within the research and information gathering realm, is it – is it salient and relevant, I guess, in that context as well? Or when we get to looking at some of the international research, you know, what are the motivations and incentives there that are most resonant?
Dr. Agilera-Peterson: Yeah, definitely. USGCRP actually has a working group on national security to tie the researchers with intelligence officials and representatives from, you know, that sector to discuss these questions in an unclassified space, as many researchers don’t have a clearance to necessarily engage in these conversations. But the research and the data are definitely of interest to lots of folks from our intelligence agencies and the Department of Defense.
And just to provide an example, last September the administration released the U.S. framework for climate resilience and security. And in there the importance of data and information is highlighted. But also, I wanted to point out that, you know, they recognize the significance of climate change on human health, but also how important it is to use data and information to create resilience, and adaptation, and mitigation now, because doing so now can save lives, save property, and produce stability now, rather than more of a reactive standpoint. So I think that proactive, trying to think ahead conversation is definitely happening between the researchers and the security communities.
Dr. Bliss: So the word “resilience” has come up quite a bit, just in the few minutes that we’ve been talking here. And, you know, I want to turn a little bit to some of these questions around adaptation and infrastructure that have come up. I mean, obviously here in the U.S. on the domestic side, I mean, we’ve seen just in recent – in the last year a number of recent examples in which climate related phenomena, whether the extreme heat, the wildfires, or flooding, has significant impacts, including on our medical supply chains. I mean, what we saw in North Carolina with the plant that was producing the intravenous fluid, and other – you know, other challenges, you know, in terms of people accessing care, you know, really brought these to the news and to people’s consciousness.
Some of the needs, as far as adapting infrastructure, you know, certainly reside in the health system – whether it’s updating or adapting hospitals and clinics and production facilities. But certainly, many others that will be relevant are much further afield as well. And so, you know, in thinking about what it will take to really move this conversation and the preparedness – Stacy, as you were saying – to really move that forward and foster, you know, I guess an adaptation economy here in the United States, who needs to be part of the decision-making? And, you know, I guess I would even add here, like, the marketing, in a way, to, you know, really get people to kind of think about, you know, preparing and preventing some of the challenges that we may see coming further along? So, Stacy, maybe I’ll start with you, and then come back to Josh.
Dr. Agilera-Peterson: Yes, thank you. I think local communities and community engagement is huge right here. We’ve seen time and again how policies and practices that might be placed with good faith don’t actually have success because local communities were not engaged. For example, in wildfire management there’s lots of great ideas, but you have to include communities if you’re going to have early warning systems that are actually effective. And to think about – you know, there’s these strategies to reduce wildland fire exposure from smoke, but that includes personnel actions. That includes community-level interactions. So if you don’t have the communities at the table and understand where they’re coming from, what their priorities are, how they’re actually able – or, what they want to do, likely it’s not going to be effective. So I would say communities.
Other – I know Josh will have other – (laughs) – ideas. But I want to say technology developers are one that I think is really important to have at the table as well, and to have technology developers working with communities, and, you know, working with – through well-established community engagement practices. You know, there is a lot – climate change, as you know, is increasing vector-borne disease cases. There’s a lot of new advances. You know, there’s vaccines, facial repellents, genetically modified mosquitoes, things like that. But if we don’t have buy-in from the communities and decision-makers, then those technologies won’t be as effective as they could be.
So those are two categories I would say definitely need to be at the table.
Dr. Bliss: So it’s interesting, I mean, you mention kind of the importance of a very locally-focused approach and, you know, to be informed by what people are – what people’s needs are and what people are willing to do, but you know, also, the potential of the innovative tech sector to build those responses. But of course, you have to have that community trust in those new responses and willingness to think about it in order to make it all kind of come together.
So, Josh, you know, thinking about some of what the adaptation economy could offer in terms of health, you know, particularly building resilience, what sectors do you see, you know, really – you know, that are – that are really missing in terms of some of the – some of the conversation particularly about, you know, kind of planning the – for things that may not be happening right away, but may be 10 or 15 years down the – down the road?
Mr. Glasser: Yeah. So I’m glad you brought this up. And as you may know, we have a White House/HHS Health Sector Climate Pledge that’s been ongoing for several years. They just announced new numbers and they have something like 960 hospitals nationwide have taken on this pledge, which is both geared at their sustainability but also resilience practices. And I think it’s incredibly important to think about those entities that deliver health care and what they can be doing, what they need to be looking at, whether we’re talking about new buildings or new infrastructure that’s being built out in many cases since the pandemic through various investments; or if we’re talking about some of that in situ infrastructure that’s been around for a very long time, was perhaps built for one type of climate and is now having to be adapted to another kind of climate.
The other set of sectors, though, that I would mention is that we’ve talked a lot about health care being a sector within a broader economy that supports public health, whether we’re talking about air, water, food, transportation, urban design, and so on and so forth. And I think it’s critical to think also about the sectors that protect public health because for – probably for better most of us do not spend that much of our lives in a hospital, but we do spend an awful lot of time eating and in our homes and drinking water and traveling to work or school. And so it’s really quite critical to think about the adaptive qualities of those services so that people can stay healthy in place and in their communities for as long as possible. And that may be a little bit of a difficult conversation because it involves working across sectors and across quite different types of industries, but I think it is an absolutely critical set of conversations to have now and to really center health outcomes as an important part of that conversation.
Dr. Bliss: So you’ve talked about the importance of kind of looking at sectors beyond human health, and I know One Health is part of you area of focus, which of course includes, you know, many of the other sectors that you’ve talked about. But one of the – one of the questions or one of the issues that has come up in some of the discussions that we’ve, you know, had here at CSIS with some of the working group – a working group that we’ve put together on climate and health is just also, you know, what is happening or what may happen in terms of changing not just human migration patterns, but animal migration patterns; and you know, as we either, you know, move further into, you know, forested areas or areas where humans and animals haven’t necessarily come into contact before, you know, what – how that may change some of the health exposures and threats as well. To what extent do you see kind of the animal health and the human health communities kind of working together to kind of think ahead and adapt in terms of, you know, changing infrastructure and the like?
Mr. Glasser: It’s an excellent question. And you’re right that this is something I’ve been working on in a lot of different capacities. I think it’s been quite interesting to see. Over the last few years we’ve moved out of a perspective where it’s really focused on the specific chains of transmission of a specific pathogen to really looking at ecosystems. And this is a space where humans and domesticated animals and even house pets and wildlife are all inhabiting the same space. They’re, you know, participating in activities, kind of cheek by jowl with one another. People are going into forests, wildlife are coming into human-inhabited areas.
And one of the big challenges with this is it’s just very difficult to pull together all of the different kinds of data that you need. It’s not impossible, and it’s getting easier and easier with some of the technology that Stacy was alluding to. But as much as it is a data problem, I also think it is a really important issue of trust. Progress moves at the speed of trust. And we need to make sure that these conversations and these types of trust-building exercises are happening now at the outset, and not waiting until it reaches a crisis point, and then trying to reverse-engineer our way back into a functioning system.
So really thinking on an ecosystem level, pulling in all the different relevant stakeholders in that ecosystem, and trying to establish the trust, the connectivity, the data sharing, the collaboration, the transdisciplinary nature – not simply multisectoral but genuinely transdisciplinary – nature of the work. That’s what needs to happen now at the outset.
Dr. Bliss: So this issue of trust, I mean, has kind of been interwoven through so many, you know, discussions about health and science, really, in recent years. And certainly there’s, you know, what Stacy pointed to, I mean, just the importance of really engaging with local communities, finding out what people’s concerns are, what their needs are, and really working with them to build systems that will enable them to continue to live their lives. What are some other areas, particularly around climate and health, that that you see as being useful or most effective in terms of building community trust?
Mr. Glasser: So one thing I think – I’ve had the privilege of being able to travel in the Pacific Islands, in the Arctic, in all different parts of Asia, and Africa, Europe and elsewhere through my work, which has been a huge privilege. And one thing that’s consistently struck me is that people often have a very good handle on what’s going on in their immediate environment. Communities probably didn’t survive for very long in frozen tundra or remote islands or other really challenging contexts without having a very good handle on how their environment works, and what their relationship was to that environment. And I think sometimes it can be challenging to begin at that level of the conversation instead of kind of coming in with maybe pre-established funding and hypotheses and things that you’re trying to experiment and work out, and then try to engage community at that point.
And the incentives of this really do have to be right to make sure that that works. On the other hand, I think really asking communities to participate in understanding and observation and even establishing what those baselines are is incredibly powerful. People have lived in these places. They know what’s going on around them. They see change as it occurs over time. And trying to harness that knowledge and work hand in hand with those knowledge holders I think is incredibly valuable and important.
Dr. Bliss: So really, you know, continue that conversation, and seeking the input of community members sort of at all levels. So this connects, I think, in some ways to this next question that I wanted to pose. Which is that, you know, there’s certainly a number of domestic initiatives that you’ve mentioned – both of you have mentioned – you know, really focused on climate and health, whether research or building, you know, programmatic outreach, or even service delivery. There are obviously a number of agencies, at least 15, doing research on many of these issues.
And so while there’s a lot happening domestically and, you know, really, I think a lot – it sounds like, a lot happening internationally as well, there doesn’t appear to be kind of a comprehensive U.S. foreign policy or diplomatic strategy on – kind of on climate and health. Now, the Global Health Security Strategy that came out in April certainly refers to climate and health. It’s kind of a small portion, but there’s certainly a reference. The new State Department global health security and diplomacy strategy, you know, has some references kind of throughout. So there’s certainly, you know, a bit there but, clearly, U.S. agencies are doing an extraordinary amount of work both, you know, on international data sets but in coordination with international partners.
And so, you know, Stacy, let me start with you and just ask, you know, to what extent do you see that there are opportunities to kind of build bridges, you know, from this research that, you know, is being carried out many times in partnership with international actors? But, you know, to what extent is it possible to kind of build on some of that work to really, you know, envision sort of a more comprehensive diplomatic strategy?
Dr. Agilera-Peterson: Yeah. It’s a great question.
I think it just – your question just ties so much into the complexity of climate change and health. These are huge issues that cross more than 15 agencies. I would say maybe every agency has, you know, some sort of relevance here.
And so, you know, I think the United States is a leader in a lot of ways. The National Climate Assessment that we produce is the preeminent report for climate information in the United States but it’s targeted to the United States, and we have the Intergovernmental Panel on Climate Change, which does a whole global approach to the scientific data and it does have a summary for policymakers.
But many countries are trying to emulate the national climate assessment that we do here for their own particular regions or countries. And so, you know, we do work closely with other partners to try to share what we do here that can be emulated elsewhere.
But, you know, it is a global conversation and I think having the COP conversations and having these annual or semi frequent conversations with just the scientific community but also others is so important because it is such a global issue, right? And so we can share what we do here, which is what we do at USGCRP.
But I think there’s a lot more work to be done because of the complexity that you just highlighted.
Dr. Bliss: So there – I mean, there are these assessments that, you know, U.S. researchers can perhaps be, you know, helpful in sharing guidance and, you know, their approaches with other countries that are seeking to build those.
Obviously, there’s the connection through the international organizations that – you know, the future of that. You know, we can talk about some of that as that develops in a second.
Josh, let me turn this around a little bit. Just – you know, I know that you have served at the State Department in the past and I think I’ve heard you talk about the international visitor programs that, you know, in some ways, you know, can serve as bridges between the domestic and the international agendas.
Could you, perhaps, say a little bit about, you know, how you see some of the potential connections between, you know, what happens, you know, domestically and internationally and if there might be a way to, you know, kind of build some of what we know about the domestic intersection between climate and health into more of a foreign policy discussion?
Mr. Glasser: Sure.
Well, certainly, I want to echo Stacy about the value of these big, broad global meetings and, of course, there’s the climate circuit, there’s the health circuit, there’s the climate and health circuit, and those do, I think, go a long way to establishing the overall priority and the overall normative ideas and frameworks for proceeding.
But I think one observation I’ve had is, again, the degree to which people are observing climate change underway in their own communities and in their own places and also the degree to which that could look vastly different if you are in a(n) Arctic tundra environment versus in a low-lying coastal state environment versus if you are in a dry land ecosystem and so on.
And so I think one of the real powers of programs that really are driven by exchange like International Visitor and others is that you are allowing for a bit of a pairing of what a(n) ecosystem and a community might look like in a foreign country with what a similar community might look like in a domestic U.S. context. And I think that’s incredibly powerful, frankly, for two-way learning. Many communities – actually, virtually every community I’ve ever encountered has been throwing their doors open and very eager to have international visitors come and share what they’ve experienced, what they see works and doesn’t work.
At the same time, international visitors do come to the United States because we are an outstanding example of so many of these areas. And frankly, a lot of that work happens in Washington, but a whole lot of it happens outside of Washington in state and local and tribal and territorial, civil society and private sector spaces. And so having a chance to actually encounter what this looks like if you’re on the ground in New Orleans, if you’re on the ground in Phoenix, if you’re on the ground in Anchorage can be incredibly powerful for helping to shape – opinion-shape how people are thinking about these issues in a way that may be very difficult to do in the big global halls with hundreds of countries and stakeholders and media cameras everywhere. I think both/and is the key here, but I would definitely say the “and” and making sure that there is that space for grassroots to talk to grassroots.
Dr. Bliss: I’m always amazed when I speak to an international visitors group or something and I say, well, where are you going next; and you know, it’s not even, like, you know, Houston or, you know, Minneapolis, it’s like Midland or Del Rio or, you know, some – they’re going to really interesting places to, you know – that are kind of off the beaten path in some cases to really, you know, talk with communities and learn. And so there are some good opportunities for that kind of exchange.
So earlier this year, in September, there was a high-level meeting on antimicrobial resistance at the U.N., another area that I know you’ve been working on at this intersection. And you know, it was notable that some of the language that came out of that, you know, really did focus or at least mention the ways in which climate change may exacerbate the challenges that countries will face in terms of antimicrobial resistance over the next period of time. And there was also a commitment to come back together to kind of discuss progress. I guess the previous one was 2016, is that right? So this one will be a little bit sooner, in 2029 if I’m not mistaken.
So I wanted to ask you, you know, the U.S. has, you know, played a strong role in terms of research on many of these issues, certainly research on AMR, research on climate and health, but you know, if the incoming administration proceeds to, you know, withdraw from international agreements on climate or withdraw from international organizations like the World Health Organization – you know, as certainly, you know, was the approach back in 2020, or certainly, you know, the stated – the stated plan in 2020 – do you – what are your – what is your sense of the prospects for continued U.S. leadership on kind of these issues around climate and health, and the – you know, both the research agenda and the policy agenda moving forward?
Mr. Glasser: Sure. I think it’s an excellent question, and I think it’s the prerogative of the incoming administration to set their policy and determine their engagement with these different organizations.
I think what I might suggest is with regard to issues such as AMR, I think there’s both an incredibly important research agenda – and I do want to turn to Stacy in a minute to talk about what that looks like across a really broad area like this, because you’re literally going from the gene to the globe in terms of scale and in terms of the different expertise you need to really unpack some of those questions. What is less, I think, unknown and clear cut is that when service delivery is interrupted, there problems do emerge. So if you are on an antibiotic regimen and a huge hurricane comes through and you have to cease that regimen or your medicine is washed away, that is bad news for antimicrobial resistance.
But let me also note that that is not exclusive to the AMR issue. That is also true if you are getting treatment for cancer. It’s also true if you’re getting treatment for diabetes. It’s also true if you’re getting treatment for HIV/AIDS. It’s also true if you’re getting treatment for tuberculosis. And so I would say, as we were talking at the top about the resilient health systems that can manage to continue to deliver services and make sure people are cared for amid shocks in their environment, I think that is the key here. And that is in some ways a more universal agenda. You’re not necessarily having to trade off treatment X versus treatment Y, or disease X versus disease Y; you’re saying that we have a system that needs to deal with the burden of disease as it exists in our communities, and that system needs to continue to provide that level of service delivery come what may. That’s certainly a domestic issue, but even perhaps more so an international issue, and something that I think the entire world is really grappling with, and AMR being an example of that particular phenomenon.
Dr. Bliss: And so the international organizations, whether it’s WHO, whether it’s some of these high-level meetings, whether it’s the international framework on climate, some of those are a way that nations come together to share expertise, to share ideas, and to develop policy. But that may not – there are other issues to consider, it sounds like, in addition to the policy. It’s just how do we, you know, think about the maintenance of – you know, the in the face of climate challenges how do we, you know, kind of maintain services? And I guess to some extent, getting back to some of what we talked about earlier, how do we also kind of protect existing U.S. investments in – or, historic, over the past 20-plus years, in many of these big global programs?
Mr. Glasser: Yeah. I think I guess how I would leave it is that people are interested in this issue. People are concerned about this issue. People who are receiving treatment are concerned about this issue. People who are protecting public health on a daily basis are concerned about this issue. I do not doubt for a second that they will continue to express concern, express interest, express innovation. How that looks, and what type of international architecture that they are operating in, remains to be seen and is the prerogative of the incoming administration. But the level of interest in addressing the issue is, I think, something that will undoubtedly remain forefront for many, many, many communities.
Dr. Bliss: So, Stacy, as you – as you look ahead to – I guess, toward the – toward the end of – a year ahead in time, to the end of 2025 and, of course, to 2029 and beyond, you know, what development, I guess, on the research side do you – you know, do you hope to see, either, you know, continued, or to take shape over the next year? What – at this kind of climate and health nexus, you know, what is one thing you’re really going to be watching as the year progresses?
Dr. Agilera-Peterson: No, thank you so much for that question. And just to echo what Josh just shared, is that, you know, any narrative that underpins a driver affecting Americans health and wellbeing warrants research. And so I think, you know, there’s the question, as we look at climate data, oftentimes we’re at a regional, maybe a county level, scale of data. But I think, more and more, we’re looking at how can we downscale that data to be more specific, to say, my particular town, my street, my address, you know, what does climate change mean for where I live, my health? And that narrowing of data, that takes a lot of technical skill and capability. And so I think we’re getting better and better at it, but over the next couple of years I do see a lot of improvement to actually be able to inform people at more of a personal and local scale.
Dr. Bliss: So, you know, coming soon, a phone app that that warns you of, you know, what’s happening on the next block and how you can take action. Well, I think it’s safe to say that you’ve given – you’ve certainly given me, and I think our audience, a great deal to think about as we wind down 2024 and look ahead to a new year and a new political administration. As you think about the work that you’ve done over the past four years, Josh, you know, what is – what is one additional thing that, you know, you hope to see by the end of 2025?
Mr. Glasser: I think it’s an excellent question. And thank you, again, for having us on for this rich discussion. I think the important point is, and will always be, that these are fundamentally human concerns, that human communities here and now are having to grapple with and address. And I think for many years there was a narrative that really framed the issue around the very, very long term and things that were out over the horizon. And there was perhaps good reason for that.
But I think at the end of the day, whether you’re sitting in Phoenix in a sweltering heat wave, or in western North Carolina as a large hurricane roars through, or in central California as you deal with wildfire smoke, these are issues that are here and now. And they are issues that we need to grapple with because they affect our life support systems. And they are what make life on Earth livable. And so I think really is driving home that concept and making those voices amplified so that people are able to share those stories is ultimately the biggest agenda and the biggest vision, perhaps, for the coming years.
Dr. Bliss: So really putting communities at the center of the conversation and responding to people’s needs, but providing the technology, the innovation, and the data to make it possible to anticipate and really plan for future challenges.
Mr. Glasser: Mmm hmm.
Dr. Bliss: Well, thank you, Stacy Aguilera-Peterson and Josh Glasser from the White House Office of Science and Technology Policy, for taking the time to talk with me today. I think this is our last broadcast of the CommonHealth for 2024. So thank you for sharing your insights and your experience. And good luck to you in 2025. Thank you.
Dr. Agilera-Peterson: Thank you for having us.
Dr. Bliss: Thank you.
(END.)